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72-12NotifAppliancePowerPanelForm_7.8.2d.doc North Commons 12-10-2021NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion. It includes a list of types and locations of notification appliance power extender panels. This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. (p. 1 of 1) Form Completion Date: 12/10/2021 Number of Supplemental Pages Attached: 0 1. PROPERTY INFORMATION Name of property: North Commons Address: 140 Orlander Dr, Northampton, Ma 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source Potter PSN-106 2nd Floor 2nd Floor EP11L-7 Potter PSN-106 3rd Floor 3rd Floor and Attic PP12L-18 See Main System Record of Completion for additional information, certifications, and approvals.